流感:雙城記

那是最美好的時代，那是最糟糕的時代

雙城記 查爾斯·狄更斯

In the Guardian a few days ago an article attempted to look at the contrast between London and Paris in terms of the Swine flu Pandemic and the cities' responses:

“Today, we seem to be experiencing A Tale of Two Cities in reverse when it comes to swine flu.

“On Thursday, the British government fired up a special swine flu website, designed to ease the burden for doctors and hospitals. It crashed within minutes as millions rushed to log on.

“On the same day in France, government introduced a change similarly aimed at helping the health service. People who believe they have swine flu are being directed to their general practitioner (GP) rather than the emergency room of the nearest hospital. The change was introduced without a murmur.”

The question was asked as to the difference in reaction between the two countries:

Swine Flu figures: UK: 100,000 VS France: 793

Population: each with around 60 million people, and are of similar prosperity.

And Britain and France are also neighbours, linked by all sorts of ties. You would expect a wave of flu in Britain to head across the Channel at some point and show up in France. Yet it hasn't happened yet.

The speculations:

“Britain is more accurate than France in reporting the number of people with swine flu.

“But I for one am dismissive of this, given the excellence of the French health system (regularly ranked in the world's top three) and especially its alert system.”

“Are the British genetically more susceptible to swine flu than anyone else?” Perhaps not.

So assuming the data on both sides of the Channel are accurate, the Guardian article continued:

-- Britain was merely the first country in Europe to experience swine flu on a massive scale. The wave will eventually hit continental Europe with the same magnitude.

-- The massive spread of swine flu in Britain can only have occurred through patterns of contact that are not the same as in France.

-- The British government's flu awareness and prevention campaign didn't work for some reason.

“Finding out what happened is essential, as it will help flu experts to understand how and why flu propagates and how to better advise the public about how to prevent infection.”

The answer may indeed be elsewhere:

New H3N2 flu variant detected in HK

Medical science in Hong Kong is a match of the best in the world and ever since SARS in 2003 they have not been complacent at all.

衞生防護中心總監曾浩輝表示，本港發現變異的 H3N2流感病毒，源自布里斯本流感病毒。而目前本港出現的季節性流感， 43%屬 H3N2流感， 49%屬甲型 H1N1流感。

曾浩輝又說，今年的流感疫苗配方，包括針對布里斯本流感，及對 H3N2流感，可發揮交叉保護作用。他建議高危人士，包括患有慢性疾病、長者及幼童注射。

The question must now be asked as Jeremy Clarkson did of Mercedes Benz on the A Class and the Elk Test Failure:

“Did they not know or did they not tell us? If they did not, they have no business making cars and if they did, well…….”

Perhaps the simpler question is:

“Did they Look?”

They did in Hong Kong.

Related:

EBM: Masks, Cathay Pacific Airline, SARS and Influenza A(H1N1)

Learning From History: 1918 Flu Pandemic, Hong Kong SARS, Swine Flu & Influenza A(H1N1) Swine Flu: WHO Level 5 & The 1976 Vaccine Disaster.

Hong Kong: SARS and Swine Flu

一百八十九宗新增確診人類豬型流感個案

流感網頁

缳生防護中心正監測變異流感H3N2病毒

流行性感冒

醫療 歷史： 豬流感與抗生素

With so much emphasis now on not using antibiotics it may be time to look at the evidence in the current pandemic of Influenza A H1N1 (to Who) and to the UK- Swine flu. News of death from Streptococcal septicaemia of a girl is reported in the Times. Should we not look at the role bacteria might play? Given a choice would you rather have Tamiflu or a broacd spectrum antibiotic?

Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness

David M. Morens, Jeffery K. Taubenberger, and Anthony S. Fauci

National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland

Background. Despite the availability of published data on 4 pandemics that have occurred over the past 120 years, there is little modern information on the causes of death associated with influenza pandemics.

Methods. We examined relevant information from the most recent influenza pandemic that occurred during the era prior to the use of antibiotics, the 1918–1919 “Spanish flu” pandemic. We examined lung tissue sections obtained during 58 autopsies and reviewed pathologic and bacteriologic data from 109 published autopsy series that described 8398 individual autopsy investigations.

Results. The postmortem samples we examined from people who died of influenza during 1918–1919 uniformly exhibited severe changes indicative of bacterial pneumonia. Bacteriologic and histopathologic results from published autopsy series clearly and consistently implicated secondary bacterial pneumonia caused by common upper respiratory– tract bacteria in most influenza fatalities.

Also: NIH Review, NPR, PBS

News: Times. Swine flu misery.

Learning from SARS : Dr Yannie Soo, Tom Buckley.

Useful link: Hong Kong Chinese University Recommendations. CDC CNN

Related:

EBM: Masks, Cathay Pacific Airline, SARS and Influenza A(H1N1)

Learning From History: 1918 Flu Pandemic, Hong Kong SARS, Swine Flu & Influenza A(H1N1)
Swine Flu: WHO Level 5 & The 1976 Vaccine Disaster.

Hong Kong: SARS and Swine Flu

SARS and Quorum Sensing

Hospital Infection: Quorum Sensing

EBM: Masks, Cathay Pacific Airline, SARS and Influenza A(H1N1)

Cathay Pacific at Hong Kong International Airport Wikimedia Commons

Hong Kong's main airline, Cathay Pacific, on Saturday backed down on its refusal to allow its flight attendants to wear face masks to protect themselves against swine flu. The change of policy came after the confirmation of East Asia's first swine-flu case in Hong Kong on Friday night and an appeal from the city's health secretary, York Chow. AFP/Standard

It is claimed that there is no evidence that the wearing of face mask is useful. So I tried to search for the evidence.

New Scientist
Face masks are best protection against SARS
02 May 2003 by Shaoni Bhattacharya

"Face masks offer the best protection in the fight against SARS, reveals a new hospital-based study from Hong Kong.

SARS HK 2003 Medical Staff in Hospital Virgin Media

"Wearing a mask can give a person dealing with SARS patients in hospital up to 13 timesmore protection compared with not wearing one, says Wing Hong Seto, study lead and chief microbiologist at the Queen Mary Hospital in Hong Kong.

"However only surgical masks and N95 masks - designed to block airborne particles - will work. These masks protect the face from droplets coughed out by infected people, which the team believes is the primary mode of spread. Seto says droplets are probably the main mode of transmission of SARS outside hospitals as well. He says the findings confirmed SARS is not spread through the air - if so only the N95 masks would have been protective.

"Face masks have become a morbid symbol of the impact of SARS in the worst-hit parts of the world. The virus has now killed 416 people across the globe, with over 6000 infections in 29 countries.

"Wearing masks in public places has become commonplace in the Hong Kong and the Chinese mainland, where the disease first emerged. But their effectiveness has been controversial and some commentators say their use has helped stoke an atmosphere of panic.

"But Seto told New Scientist: "Masks seem essential for protection. This finding fits well with droplet transmission, because droplets are generated at the face level."

Statistically significant

"Seto and colleagues from five Hong Kong hospitals and the University of Hong Kong, surveyed over 250 hospital staff exposed to 11 SARS patients between 15 March and 24 March.

"Most of the 13 staff who became infected did wash their hands, and a handful also wore gloves or a paper mask, but none had used a surgical or N95 mask. Analysis of the data showed that the use of surgical or N95 masks was the only measure to give statistically significant protection.

"Paper masks offered little protection, says Seto. 'Such masks, being easily wet with saliva, are never recommended as a precaution against droplets.'

"However, not one of the 69 staff who had used all four recommended protection measures - wearing a mask, gloves, gowns and washing their hands - contracted the virus."

"Seto believes the risk of contracting SARS in public places is 'very low' and so does not wear a mask himself. 'However, I have it ready if I am in a crowded place,' he says. 'I see someone consistently coughing, then I put it on. If I see he is febrile, I strongly advise him to go home and see a doctor. Then I wash my hands and take a good shower on coming home.'

Journal reference: The Lancet (vol 361, p 1520)

It has to be accepted that there is virtually no rubbish collecting facility in public places in the UK due to worries about bombs and there are no hand washing facilities on buses and other public transports. See NHS Direct Advert.

In any case, Hong Kong has now a second case of of Influenza A (H1N1); a passenger on Cathay Pacific flying in from the US. There has been no local spread so far.

WHO H1N1 UPDATES

SARS ACCOUNTS: Dr Yannie Soo, Tom Buckley.

Useful link: Hong Kong Chinese University Recommendations. CDC CNN

Other Posts:

Learning from History: Swine Flu & Antibiotics

Learning From History: 1918 Flu Pandemic, Hong Kong SARS, Swine Flu & Influenza A(H1N1)
Swine Flu: WHO Level 5 & The 1976 Vaccine Disaster.

Hong Kong: SARS and Swine Flu

SARS and Quorum Sensing

Hospital Infection: Quorum Sensing